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1 LIBRARY OF CONGRESS. 1 

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86 



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H UNITED STATES OF AMERICA, g 



V 



I 



THE CHOLERA: 



ITS 



CAUSE, PREVENTION, AND CURE. 



BY 



m 



CHARLES RICHARDSON, M. D. 



NEW-YORK : 
D. APPLETON & COMPANY, 200 BROADWAY 

PHILADELPHIA I 

G. S. APPLETON, 164 CHESNUT-STREET. 
1849. 



V 



Entered according to Act of Congress, in the year 1849, 

By D. APPLETON & COMPANY, 

In the Clerk's Office of the District Court of the United States for the Sonthern District of 

New- York. 



INTRODUCTION. 



TO THE PUBLIC. 



Having from circumstances seen considerable of Asi- 
atic cholera in 1832, some time since 1 wrote out hastily 
the following, with a view to its publication in the pa- 
pers. Want of room prevented its insertion in the daily 
papers to which it was offered. I hoped that my rough 
notes might lead to some useful hints which, in more 
able hands, might supply my mite to arrest the approach 
and mitigate the malignity of this horrible disease. I 
do not pretend that this work is a scientific treatise 
upon the cholera, it never was by me intended to be 
such ; but only a plain blunt statement of the (in my 
opinion) cause, preventive, and curative means fit to be 
placed in the hands of all. The frequent repetitions 
are purposely made, so as to impress my meaning dis- 
tinctly on the w T eakest minds, and make my advice useful 
in cases of emergency, w r here, as is often the case, med- 
ical advice cannot be immediately obtained. I ask no- 
thing but a fair trial of my mode of treatment ; if the 
portending disease be similar to the last, I feel confident 



4 INTRODUCTION. 

that it will be successful ; if different, the treatment 
may require some modification. Not being in the habit 
of writing for the press, I trust any ambiguity in explain- 
ing my meaning, will be viewed with indulgence, over- 
looking the incapacity of the writer in the importance of 
the subject on which he has endeavored to throw some 
light, however feeble, to avert and remedy so deplorable 
a calamity. 

I shall feel fully rewarded if, from the following 
crude remarks, any one suggestion shall be made avail- 
able in arresting or mitigating so dire a scourge, and 
if only one human being should be snatched from an 
untimely grave through their agency. 

To the notes on Cholera Infantum and the cure of 
Shipley's servant, I particularly solicit the attention of 
the public, — hoping in the first, if followed, it may di~ 
minish the dreadful mortality among children, and the 
second, (death from drinking cold water when over- 
heated) if on repetition, the remedy is successful, that 
at last an antidote has been found for what has hereto- 
fore been a desideratum in medicine. 

I have written the following in the first person, not 
from any assumption of egotism, but simply because it 
was more easy and natural so to do ; the dogmatic and 
positive tone assumed, was for the purpose of more 
deeply impressing on the minds of all what I consider 
momentous truths. 

Respectfully, 

CHARLES RICHARDSON. 

Baltimore, June 1st, 1849. 



CHOLERA 



The threatened approach of the cholera makes it a 
point of wisdom that every means should be employed to 
avert its attack, or if that be impossible, to mitigate its 
violence, and thereby render it more easily relieved, by 
a judicious course of medical treatment. 

Having been employed by the city of Baltimore du- 
ring the prevalence of the cholera in 1832, to take charge 
of one of the medical districts, a large number of cases 
fell under my care ; and thinking that the facts observed, 
and the experiments instituted by me, conclusively prove 
the origin or cause of cholera, and by consequence, the 
proper preventive and curative means, I shall forthwith 
proceed to state them. 

The origin of cholera I believe to depend upon a 
minute diminution of the vitality (oxygen) of the atmo- 
sphere. This may arise either from a less portion of 
oxygen or the admixture of some other ethereal sub- 
stance with the air ; and I maintain that this hypothesis 
will account for every incident in cholera. Nine out of 
ten cases I saw, were in a state of collapse when I was 



6 CHOLERA. 

called to them, and in what follows I shall invariably re- 
fer to that stage of the disease, unless otherwise stated. 
The prominent symptoms were, a cold, clammy, 
doughy state of the skin — no pulse — very slight or no 
perceptible action of the heart — hippocratic appearance 
of the countenance — no secretion from the kidneys or 
any other organ— very seldom, although occasionally, rice- 
w r ater dejections from the bowels — often cramps — slow r - 
ness of speech — faculties of the mind perfect — great tor- 
por and want of excitability. Searching for the cause of 
this disease, I was first led to examine the electrical state 
of the atmosphere. From many experiments I found that 
the fluid could by friction be accumulated in the ordinary 
time, as previous to the prevalence of the disease, veri- 
fied by many experiments since. In six cases I isolated 
the subject of disease, charged the system with the fluid, 
keeping one case in this state for five hours. As a re- 
medial agent I found it in no instance of advantage. 
Independent of this, there was the usual quantity of 
thunder storms during the prevalence of cholera. The 
galvanic battery, on examination, exhibited nothing un- 
common in its accumulation or action. I then turned 
my attention to the atmosphere. I thought I discovered 
in myself and others a degree of languor, and some 
slight increase of respiration, or more hurried breathing. 
On subjecting this to experiment, I found in many in 
health, from one to five inspirations more than ordinary 
in the minute ; in fact, in most persons, by a little exer- 
tion, the respiration was more easily hurried than com- 
mon. The blood in man is of two kinds, venous and 
arterial — all the secretions, with one exception, are per- 
formed by the extreme capillaries of the arteries. The 
venous blood is changed into arterial or secretory, by 



CHOLERA. 7 

being subjected to the action of the air inhaled by the 
lungs. The common doctrine has been, that there was 
an absorption of oxygen, which, combined with the 
venous, converted it into arterial blood. A more mod- 
ern theory is, that decarbonization of the venous, converts 
it into arterial, blood. I believe there is an actual ab- 
sorption of oxygen, yet think the oxygen may perform a 
double purpose, by removing the excess of carbon in the 
form of carbonic acid. Without an absorption of oxygen, 
the bright vermilion color of the blood could never be 
maintained. But to let all theory pass — I am writing so 
that every one may understand. Avoiding all technicals 
as far as possible, I come to the simple fact, which all 
know, that no animal, for any length of time, can exist 
without a supply of air, and that through the air, im- 
bibed by the lungs, there is some change effected in the 
blood which is necessary to the life of the animal. Now 
this change I believe to be the absorption of oxygen and 
its combination with the blood ; and I further believe this 
oxygen in the blood to be the stimulus to all secretory 
action. I also maintain, that the diminution in the 
vitality of the atmosphere may be in such a slight pro- 
portion as to produce dire consequences, and yet be 
imperceptible to any chemical agents yet known ; and 
although, by analysis of the air, no perceptible change 
can be perceived in its component parts, yet in its 
effects as a chemical agent, in processes dependent on 
atmospheric action, the fact of a diminution of the 
vitality of the atmosphere can be as demonstratively 
proved, as if upon analysis there was found a less pro- 
portion of oxygen, one of its constituents. 

Believing as above, I obtained, through the polite- 
ness of Doctor Ducatel, Professor of Chemistry in the 



8 CHOLERA. 

University of Maryland, a large portion of pure oxygen, 
prepared by him, as also nitrous oxide. The first case 
in which I used these agents was John Bates of Union- 
street ; he was in an advanced stage of collapse when I 
saw him ; I gave to him the bladder containing nitrous 
oxide. He imbibed 150 cubic inches with no percep- 
tible effect. I then combined 120 cubic inches of at- 
mospheric air with the same quantity of oxygen, but 
yet with no effect. I exhausted of this mixture 500 
cubic inches. I then proceeded to give him the pure 
oxygen. On the second or third inspiration (although 
in his case there was no perceptible action of the heart 
or arteries) there was a large full pulse, and after in- 
haling about 150 cubic inches, a brightened appearance 
of the countenance, and an excessive eagerness to grasp 
and retain the bladder, although exhausted of the gas. 
This man imbibed about 450 cubic inches of oxygen ; 
during the whole of which time the pulse was large, 
regular, and soft, but in less than two minutes after he 
ceased to breathe the oxygen, the heart ceased percep- 
tibly to act, and there was no pulse at the wrist. This 
was the invariable action of the inhalation of oxygen in 
some twenty other cases, which fully led me to believe, 
that if a person could, in a state of collapse, have been 
supplied with pure oxygen for a sufficient length of time, 
it might have removed the disease. 

Now, the cholera is a disease of great torpidity, and 
want of excitability, and in the successful mode of treat- 
ment I adopted, I found that a dose of medicine, to 
act beneficially, must be increased about five times in 
strength ; the vitality of the system (living, not dead 
matter,) is what medicine acts upon, therefore it must 
be evident to all, however unlearned, that if the torpid- 



CHOLERA. 



ity of the system is five times increased, or its excita- 
bility five times diminished, the dose of medicine should 
be proportionally increased, and the interval between 
each dose diminished, to have the same effect as on a 
person in ordinary health. This view of the case was 
most lamentably neglected by many physicians, and 
very many persons lost their lives by want of energy 
and prompt efficient action, in the adapting the dose of 
medicine, and its repetition to the susceptibility of the 
system. After these experiments with the oxygen, I 
proceeded to examine the lead factories, some of the 
products of which are partly dependent on atmospheri- 
cal oxydation, and was informed by Mr. Gist that the 
production of some of his chemicals, which in ordinary 
times took from three to five days to perfect them, dur- 
ing the prevalence of cholera took from thirteen to fifteen 
days. On examination I found this to be the fact. I 
now considered that further experiments were super- 
fluous, as this fact conclusively demonstrated the want 
of the usual vitality of the atmosphere. In further proof 
of my hypothesis, the disease did not occur in small 
villages, or in the country, where the air had a freer 
circulation, and was of course purer than in crowded 
cities. Having by all the above, I think, fully proved 
the deficiency of the vitality of the air, I shall proceed 
to notice what would be the effect of the deprivation of 
the due proportion of oxygen in the blood, and the first 
parts which would become disordered by this deficiency. 
1 believe it is self-evident, that the extreme arterial 
capillary, or secretory extremities, would be the first 
affected. This is the fact in cholera — no secretion from 
the kidneys — I have seen many cases in which not one 
drop was secreted by them for five or six days ; all other 



10 CHOLERA. 

secretions were in the same state. The matter thrown 
up by vomiting, and from the bowels, is no secretion — 
a mere exhalation, proved, in my opinion, by the dissec- 
tion and examination of several cases by myself, as also 
some in conjunction with the late Dr. Warner. In these 
cases, by the application of a microscope of large mag- 
nifying power, the mouths of the exhalent or secretory 
vessels of the internal coat of the bowels were percepti- 
ble to the eye — apparently the walls very much relaxed, 
and calibre increased in volume ; in fact, they had lost 
their accustomed stimulus necessary to their legitimate 
action of secretion, became relaxed, and poured out 
this rice-water exhalation. I do not believe the disease 
of cholera is perfectly formed until collapse occurs, after 
which there is very little of this exhalation. Now what 
would be the effect, in a person in health, of a sudden 
stoppage of secretion ? — certainly a collapse of the vital 
power. This is cholera. There is said to be little or 
no secretion and absorption in the brain — how is the 
mind in all cases of cholera ? why, clear and undisturbed 
in all its faculties, as in health. In many parts of Ger- 
many, and some of Russia, as well as in Persia, and in- 
deed in some parts of the United States, large bonfires 
were resorted to as a preventive to the spread of cholera. 
Invariably, wherever this means was used to any extent, 
it was found to increase the number of cases, and the 
malignity of the disease. The cause is obvious to all. 
Combustion is fed by the oxygen of the atmosphere. 
The great source of the supply of oxygen to the atmo- 
sphere, is that of the absorption of carbon, and the dis- 
engagement of the oxygen by vegetable matter. It 
would be a subject of peculiar interest — a scientific 
examination to ascertain if the great destruction of the 



CHOLERA. 11 

forests and other vegetable matter, and the immense 
increase of combustion all over the world, might not lead 
to a disturbance of the just equilibrium of the production 
and consumption of oxygen, so as to leave the world 
(saying that my hypothesis is correct) subject to periodi- 
cal invasions of the cholera. 

If I find that the public think that these notes, 
loosely and hurriedly thrown together, may be useful, I 
shall be tempted in my next to proceed to show the true 
preventive means, as also to take into consideration the 
various remedies most popular with physicians for the 
cure of this disease — the fallacy of the autopsic state, on 
which most of these remedies were predicated, and 
many curious examples of the inertness of the means 
used. 

I believe, if the approaching epidemic assumes a 
character similar to the last, that with proper treatment, 
four per cent, should be the greatest loss in collapsed 
cases, and in its primary stages, without the constitu- 
tion is worn out by previous disease, or destroyed by 
excess in drinking, or other injurious habits, every case 
should be cured by prompt and active treatment. 



12 CHOLERA. 



PREVENTION-GENERAL AND PERSONAL. 



The foregoing statements being admitted, the real pre- 
ventives are obvious to all, viz., to remove every species 
of fermenting matter, either vinous, acetous, or putrefac- 
tive, and to reduce the consumption of oxygen by com- 
bustion, to the very lowest degree possible. In all re- 
commendations of preventives this last, combustion, has 
been altogether overlooked, and it would appear strange 
that among so many men of the most acute genius, and 
learned in all sciences, that this, the great destroyer of 
the vitality of the air, should never have been once 
mentioned, but that all have joined in the echo for the 
removal only of putrefactive matter, merely one of the 
agents of the deterioration of the atmosphere ; to be ef- 
fective as general preventives, all agents that absorb the 
oxygen of the atmosphere must be as far as possible dis- 
pensed with. In one word, I recommend the removal 
of all matter subject to fermentation, as well vinous 
and acetous as putrefactive ; and above all, to reduce 
combustion as above, to the very lowest degree possible ; 
and in fact there might be circumstances in w T hich the 
public safety might call for the stoppage of all manufac- 
tories which consume oxygen either by combustion or 
otherwise, even if the public purse should have to pay 
damages to the owners thereof. 



CHOLERA. 13 

The best personal preventives are cleanliness and 
great attention to diet, regularity in every thing, a fixed 
hour to sleep, the same to eat, excess in nothing, 
temperance in all things, vegetables and fruits of all 
kinds should be avoided as dangerous — beefsteaks with 
rich gravies I found best, occasionally ham ; a few ate 
potatoes, which had fully come to maturity ; salt fish 
was also much eaten, fresh fish very seldom ; bread I 
never ate ; soda and water crackers, and ship-biscuit are 
best ; coffee and tea were generally used. There was, 
during the prevalence of the disease, a tendency in all 
to looseness of the bowels ; many resorted to tonics and 
astringents, some to burned brandy ; this was very inju- 
rious ; on the contrary, provided it was done with proper 
medicines, an occasional purgative was of the greatest 
use as a preventive, and many who had the premonitory 
symptoms strongly marked, were entirely relieved by 
taking two or three pills, prepared from a recipe made by 
me, every two or three days. These pills were alterative 
and gently laxative, and created no disturbance in the 
system. To their occasional use by myself, as well as 
many hundred others, I attribute their and my escape 
from the cholera. I regret that before my determination 
to publish these loose and undigested notes and recollec- 
tions of the cholera, I had sold this recipe to Mr. 
Charles P. Rogers, Druggist, of Baltimore, so that I am 
in honor bound to do contrary to my wish, which was 
to make it public. These pills, however, can be obtain 
ed in any quantity from him, pure and genuine. 



14 CHOLERA. 



POPULAR REMEDIES. 



The Cholera being a new [Note I.] disease of 
which very little was known, coming upon us suddenly 
for the first time in 1832, the Medical Profession were 
at a loss what mode of treatment #was most proper. 
Every thing was recommended, and strange to say, 
continues to this day to be recommended. Many things 
were used, some the most preposterous and unreasona- 
ble •; no matter how absurd or inert the nostrum, still to 
many it was a certain specific. Among them were direct 
contraries, to wit : hot bath — cold bath ; rubbing and 
roasting before the fire — freezing with ice ; bleeding, hot 
stimulating drinks — ice-water, &c, &c, all cured their 
myriads, yet still the cholera progressed. In fact, it 
appeared as if the Faculty were startled and thrown off 
their balance, and all was chaos. But as light is often 
said to come out of darkness, I trust that if the cholera 
invades us, it will be met by all with calmness, — the 
Faculty especially ; (who are not exceeded in learning, 
deep research, and acuteness in adapting the means to 
the end, by that of any other nation,) who, by applying 
the ordinary rules of the profession, to an extraordinary 
disease, will readily fall upon the best curative means. 
Indeed, I am fully convinced, that 90 out of 100 cases 



CHOLERA. 15 

would have been cured if they had occurred in ordinary 
times, when there was no excitement, by applying the 
common rules of the profession. 

The three most popular remedies were bleeding, 
camphor, and opium. When the disease first appeared 
in America, European prescriptions were resorted to ; 
in New-York the recommendation of the Physicians of 
Canada, — in Philadelphia those of New- York, — and in 
Baltimore, those of Philadelphia ; for this disease trav- 
elled from north to south, and within a few weeks' interval 
from city to city, so that it occurred a few weeks later 
in Baltimore than in Philadelphia, and the remedies re- 
commended there, were those first resorted to in Phil- 
adelphia, the most prominent of which were bleeding, 
and calomel, and opium. 

Bleeding, I never found admissible in any case, but 
saw many sink under its operation that I thought might 
have been saved. I was sent for in nine cases, one after 
the other, where, before I arrived, another physician 
had been called in ; he immediately proceeded on arrival 
to let blood. In eight out of the nine cases he had 
either just done bleeding, was in the act of tying up the 
arm, or the blood was flowing when I arrived. Some 
died in the act of blood-letting, and none survived above 
half an hour. From a pound to a pound and a half 
was taken from each of these persons. In the ninth 
case I arrived when the Dr. was tying the ligature about 
the arm preparatory to bleeding. I looked around and 
saw five interesting little children, the mother, who was 
the subject of disease, a respectable German lady, residing 
in Saratoga near Cove-street. I craved a conference 
with the Dr. and objected strenuously to his bleeding 
her, stating to him that I had seen him bleed profusely 



16 CHOLERA 

eight other persons within a week, several of whom died 
under the operation, and none survived half an hour ; and 
that I would not consent that this ladj should be bled. 
His reply was, What could be done then ? — that bleed- 
ing was the true treatment, for the disease was depend- 
ent on mucous congestion in the bowels, according to 
autopsic examinations made in Philadelphia. (Of this 
more hereafter.) I recommended the remedies used 
by me and mentioned in the sequel, which were suc- 
cessful, and this lady recovered. 

Respecting congestion in the intestines, I examined 
several cases after death, and it is true there appeared to 
be an accumulation of blood in the vessels of the bowels ; 
but on minute examination I discovered that the appear- 
ance was fallacious, for to be congestive, it must be in 
the arteries ; whereas it was a mere turgidness of the 
veins. In fact, the blood had to be in some part of the 
vascular system after death ; where there was the least 
muscular pressure, there the blood would be, and there 
in most cases it was found, in the veins of the bowels. 
Such was the fact, and by adapting the remedies to the 
living in this disease, (as in many others,) founded on 
the fallacious deductions drawn from the examination of 
the bodies of the dead, many thousand persons lost their 
lives. 

This is a disease of partial or entire stoppage of se- 
cretion ; foster what little life is left ; if you apply pow- 
erful stimuli, the weak vitality is overwhelmed and 
smothered, and the person dies. If you abstract blood, 
the feeble flickering flame of life is at once destroyed, 
and the person ceases to exist. On the contrary, by 
every measure try and sustain life, until the proper 
means hereafter mentioned shall have cleared the ma- 



CHOLERA. 17 

chine of the pressure of the disease. I have often seen 
much done in half an hour, — generally one hour will 
suffice to place the person in the lowest state of col- 
lapse in comparatively a more safe position, if the effi- 
cient mode of treatment to be mentioned is pursued. 

Camphor of all other things has been most gener- 
ally used ; it has been lauded as a sovereign preventive 
and cure, especially camphor-water ! ! ! Why not also 
brick-dust ? for the one is nearly as inert as the other, 
for all are aware how little camphor water will dissolve. 
The motive which originally led to the use of camphor, 
was its supposed quality to relieve the cramps; but to 
settle the matter with few words, the cramp is not the 
disease, but the mere effect of the disease. The great 
mistake in the treatment of this disease, has been, 
that most of the remedies have been to relieve the ef- 
fects of the disease, and not the disease itself. It is 
a known axiom in Philosophy, that remove the cause 
and the effect will cease. Storm, then, the disease, in 
its stronghold, relieve it, and then all its mere effects 
cease; to wit: — the vomiting, the rice-water dejec- 
tions, cramps, &c. 

I saw, and shall narrate from my notes, a melan- 
choly case, of a family treated by camphor. I was 
called to the family of a Mrs. Baily, living near Hart's 
Factory, in the suburbs of the town, about 12 o'clock 
in the night of the 13th of October, 1832. I arrived 
about 1 o'clock, and was informed that 2 days before, 
the father had died of cholera, one son was lying dead in 
the house, from the same disease, and a son and daugh- 
ter, adults, were lying in a state of collapse, having 
been sick many hours. 1 inquired what remedies their 

family-physician, who was said to be rich, had prescrib- 

2 



18 CHOLERA. 

ed ; I was told that the only remedy used in the cases, 
was a table-spoonful every 2 hours of Camphor water ! ! 
The most powerful of the remedies to be mention- 
ed were employed by me, and I am happy to say, both 
brother and sister recovered, and the last I heard of 
them, had large and interesting families around them. 
While I was attending to these persons, a little girl 
about 12 years of age, a sister, commenced crying, 
pressing her hands on her stomach and vomiting, with 
cramp. I immediately administered the same reme- 
dies in a less portion to her, and she never went into 
collapse, but in a few hours was out of danger. 






CHOLERA. 19 



TREATMENT. 



1 come now to the treatment, and the means I 
used. 

The first case I saw was a man in Union street, in a 
state of collapse ; I followed the Philadelphia practice, and 
administered calomel and opium ; the man soon died, and 
I discovered that I had done nothing for him ; in fact, the 
one medicine had counteracted the operation of the other; 
being a disease of great torpor, and want of excitability, 
the opium, by increasing the torpor of the system, neu- 
tralized the action of the calomel upon the secretions. 
In this case, blisters, sinapisms, rubefacients with heat 
were untiringly used, but with no effect. 

In the first or forming stage of the disease, known by 
nausea, laxity of the bowels, evacuations of natural 
color, occasionally slight cramps in the hands and feet, 
&c, all cases can be cured ; the remedy is mercurial pur- 
gation. The calomel should be given in rather larger doses, 
and less interval between each dose than in ordinary 
times, until free mercurial purgation is effected, which 
should be continued until copious bilious discharges are 
produced, after which there is no danger ; for in several 
hundred cases, no matter how violent, I never saw a free 
bilious discharge produced but the disease soon yielded, 
and all danger was over. — [Note 2.] 



20 CHOLERA. 

Now I do not consider that the return of the secre- 
tion of the liver is the sole cause of the removal of the 
disease, but view it as the first visible sign of return of 
the secretory process, and hail it as the first harbinger of 
hope ; for as the Ptyalism convinces us that the mercury 
has invaded the whole system, and is only useful as a 
beacon,, so the bilious discharges notify us that the 
greatest agent for the excitement of capillary action or 
secretion, with the exception of the stimulus or oxygen 
of the blood, is energetically at work, and the disease 
must soon disappear. 

No purgative should be taken after the calomel, but 
a very light diet. Tonics are inadmissible and unne- 
cessary ; aged or weakly persons, in an advanced stage 
of convalescence, occasionally find benefit from them ; 
however, I think they are of doubtful effect, and to be 
avoided, if possible ; for if the secretory process is not 
universally re-established, there might be danger of 
their producing obstruction, and laying the foundation 
of chronic diseases, which, if not incurable in their na- 
ture, might lead to much trouble and suffering in the 
sequel. In speaking generally of the secretory process, 
I wish it understood that I refer not only to the glandu- 
lar discharges, and arterial deposits, but also often in- 
clude the absorbent and lymphatic vessels. 

The next stage of this disease is characterized by 
violent cramps, severe vomiting, frequent rice-water 
dejections from the bowels, &c, in fact, the disease is 
now verging to its complete formation ; this state is 
very dangerous, but yet with energy 99 out of a 100 
can be prevented from going into collapse, (or having 
the disease completely formed,) and can be cured. The 
remedies are sinapisms of mustard over the whole chest 



CHOLERA. 21 

and abdomen, 15 to 25 grains of calomel every hour or 
two hours, until free mercurial purgation is produced, 
continuing the mercury at longer or shorter intervals, as 
the urgency of the case requires ; in some cases I have 
had to continue the calomel 24, 48, or even 60 hours, 
gradually diminishing the dose as the most violent symp- 
toms disappeared, until I could safely omit it, and then 
gave the sweet spirits of nitre, which acted powerfully 
in restoring the secretion of the kidneys and healthy ac- 
tion of the skin. 

I come now to the last stage, that of collapse, where- 
in the whole vital power is prostrated by the disease now 
completely formed. The action of the heart nearly ceases, 
there is no pulse at the wrist, the skin is cold, doughy, and 
clammy; cramps are occasional; the vomiting and diar- 
rhoea in a measure, cease, and yet the mind is composed, 
and with the exception of slowness of reply, perfect in its 
action as in health. This stage requires the greatest 
activity in treatment — what in ordinary diseases and 
times is done in hours and days, must now be done in 
minutes. There is great torpor and want of excitability ; 
blisters will not act, sinapisms produce little or no effect, 
the skin is apparently dead. Internal stimulants you 
cannot use, for they will overwhelm the feeble remnant 
of life : all evacuants are inadmissible, for they produce 
direct prostration and death. Here, then, is a stage of 
disease in which nearly all curative means are contra-in- 
dicated. What then can be done r Why, the only spe- 
cies of medicine that can be used is such as will stimu- 
late and restore the secretions — that is, calomel. Its 
action is first alterative, and then purgative ; by its al- 
terative and stimulating action it relieves the pressure of 
the disease, and enables the system to sustain the sub- 



22 CHOLERA. 

sequent purging, for it is well known that of all purga- 
tives the evacuations by calomel are least exhausting. 
Why, in the very lowest stages of ordinary cholera mor- 
bus, is it always given in large doses without fear of 
prostration, but for its known action as a corrector and 
restorant of secretion, the disease being dependent on 
vitiated secretion, or the state of the organ producing 
vitiated secretion ? The remedy that w 7 ill remove ob- 
struction in an organ and restore the natural secretion, 
must certainly be alterative, or act as a stimulant to the 
secretions. This is what we want in cholera. Calomel 
is well known to possess this power in a greater degree 
than any other medicine. Calomel is then the medicine 
for cholera. I have used it in many hundred cases of 
the disease in the very lowest stages, and the very worst 
subjects for disease, the paupers of a large and populous 
city, and have seen them deprived of every thing, having 
nothing, not even a bed to lay on, (for many refused to 
be carried to the hospital,) yet under its operation reco- 
ver within two or three days, from the very lowest sta- 
ges of collapse : this was not only in one or two cases, 
but in hundreds. — [Note 3]. But this happy effect has 
not been produced by giving 5 or 10 grains, and after 
three or four hours working it ofT, as is usual, with cas- 
tor oil or rhubarb, or combining opium with it to neu- 
tralize its effect under the mistaken idea of stopping a 
symptom, or effect of disease. No, the urgency of the 
case is so great, life is lost if trifled with. In many ca- 
ses I have given 50 grains every half hour, until evacu- 
ations were produced, and have seen it act as a charm 
in 50 minutes, the cramp, vomiting, and most of the 
prominent symptoms having measurably ceased. My 
usual practice was to continue the calomel in large do- 



CHOLERA. 23 

ses until the urgency of the case was partially over, but 
yet the calomel had still to be continued, in most cases 
for 24 hours, (sometimes far longer,) diminishing the dose, 
and increasing the interval, as the relief of the disease 
would allow. Now, to many, this would appear ul- 
tra, dangerous, and extravagant, but what I now state 
was learned at the bed-side of the dying and the dead. 
An honorable duty was put upon me by my native city, 
to stand between my fellow-man and the most ghastly 
disease. Under any circumstances, indecision would 
have been criminal, and most would have died. I found 
that calomel, and calomel only, would relieve the disease. 
I used it, and that fearlessly, and the effect was, with the 
aid of two other means, hereafter to be mentioned, that 
out of many hundred cases that fell under my care, ex- 
cepting the first case, there were only thirteen deaths. 
The accounts of deaths are on record, and can testify 
for themselves. 

I have heretofore stated, that cholera is a disease of 
great torpor, and that medicine acts only on vital, not 
dead matter, and often when giving 50 grains of calo- 
mel every half hour, I did not consider that I was giving, 
under the circumstances, a stronger dose than 10 grains 
in ordinary times, and under ordinary circumstances ; 
and the physician, who at the bedside of the patient, 
gives his medicine by rote (" 10 grains of calomel, and 20 
of jalap, is good for bilious fever, worked off with salts 
and senna-tea ") is no physician ; the patient would have 
a better chance without him, depending only on nature. 
The dose of medicine must, to be useful, be proportioned 
to the susceptibility of the system ; and if this suscepti- 
bility is greatly diminished or almost destroyed, as in 
cholera, the wise practitioner, who does his duty, never 



24 CHOLERA. 

stops at quantity, but as far as his judgment allows, 
adapts the means to the end. To show with what im- 
punity violent medicine may at times be used, I will 
abstract from my notes the case of Major Henry Well- 
ing of Elkridge. He was a man of a phlegmatic, torpid 
temperament, stout and strong, about forty years of age, 
who had been habitually subject to attacks of bilious 
fever of a high grade, for the last fourteen years preced- 
ing the time I was called to him, which was in the year 
1822. I found him laboring under a severe bilious fever. 
The ordinary remedies were used, but not with much 
effect, and as the disease progressed, about the tenth 
day I discovered that there was an obstruction in the 
gall duct, and that the gall bladder was very much dis- 
tended, so much so, that fluctuation was perceptible to 
the fact. His whole system appeared to be torpid, and 
from the pressure upon it, the vital power seemed to be 
prostrated and overwhelmed, evidently indirect, for the 
muscular energy was considerable. The pulse was in- 
termitting, and forty strokes in the minute. There was 
a pecular idiosyncracy about this man, which was that 
from a boy, tartar emetic would seldom or never vomit, 
or even nauseate him. As night approached, the urgency 
of his case increased ; to dislodge the obstruction was 
absolutely necessary, for I was convinced that before 
morning the cyst would burst and destroy him, and this 
could only be done by vomiting. I gave him 24 grain 
doses of tartar emetic at intervals of twenty minutes 
with no effect. Other emetics were used in vain. 1 
then took his brother aside, and told him that, every 
thing ordinary had been done, and without effect, and 
that he could not survive until morning, unless the ob- 
struction was removed. That there was one remedy 



CHOLERA. 25 

jet untried that occurred to me, which was corrosive 
sublimate — that it had never been used in such a case, 
but that I had seen my much honored preceptor, the late 
Doctor George Brown of Baltimore, use it with success 
on a case of croup, where the membrane was partially 
formed. That this remedy, if it did not vomit him, would 
destroy him, and I thought it right to mention it to his 
friends, for I considered his case desperate, and the pro- 
posed remedy more desperate. The brother's reply was, 
additional professional aid should be called in if I thought 
proper. I told him it w T as too late, for the distance was 
so great that he would be dead or relieved before help 
could arrive — that I should leave it to the Major, having 
notified to his friends the desperate nature of the re- 
medy. I then bluntly told the Major that his case was 
hopeless unless he could be vomited. That there was 
only one means left, and this was of so violent a nature, 
that if it did not vomit him it would destroy him ; and 
that 1 thought it my duty to give him his choice. His 
reply was, " Give it to me, Doctor." I commenced 
with 2 grains, then 3, then 5 grains every twenty 
minutes, until he took fifteen grains of the sublimate. 
I then gave him 9 grains, and in a few minutes it com- 
menced to act as an emetic and cathartic, violently. 
The amount of discharge would be incredible if men- 
tioned, but there are many living witnesses to the fact. 
It was only by the most powerful stimuli that life was 
sustained. He, however, soon recovered, and never 
until his death, which took place in 1842, was attacked 
with bilious, or any other disease. Here is a case, then, 
that the remedy used with success, under the circum- 
stances, would be certain death in a different case ; yet 
by the use of this apparent violent remedy this man was 
restored, and gained twenty years of life. 



26 CHOLERA. 

The calomel, then, is my remedy, which seldom 
failed in doses from 20 to 50 grains, at intervals longer 
or shorter, as the necessity of the case required, com- 
mencing with large and powerful doses, repeated at short 
intervals, until the pressure is removed from the vital 
power, then not omitting its use, but diminishing the 
dose and increasing the interval, until the free action of 
the system is restored, after which sweet spirits of nitre, 
largely diluted with water, should be taken as a common 
drink, for in many cases after the necessity for the con- 
tinuance of the calomel has ceased, the secretion from 
the kidneys is not restored. 

No nourishment is necessary in the height of the 
disease, afterwards mild slops made from tapioca, sago, 
&c, are best. 

As calomel brings certain relief, if properly given, 
now the great difficulty is, in many cases, to prolong 
life until the calomel can act. Internal stimulants, for 
reasons before stated, cannot be used ; too much heat 
applied externally, I have seen produce the same effect 
as stimuli taken internally. We are then reduced to 
friction and sinapisms. The former I have never noted 
as being particularly useful, the latter I always used, 
spread all over the chest and abdomen, generally with 
good effect. But again, there were many cases in 
which I was called so late, that the sinapisms had no 
more effect than if they had been applied to a board. 
Now it was precisely for this state that I introduced a 
mode of treatment which, I trust, was the means of sa- 
ving many lives, for I used it in more than 150 cases, 
with almost universal success. It was, when I found 
the person was so low, that mustard, red pepper, &c, 
lost all stimulating effect, I introduced the practice of 






CHOLERA. 27 

taking the whole of the scarf skin off the chest and 
abdomen, by flannels dipped in boiling water, and ap- 
plied. I literally scalded the whole Epidermis off, re- 
moved it, and applied sinapisms, if 1 may use the term, of 
equal quantities of African red pepper and mustard to the 
naked extremities of the nerves. I generally found, so 
applied, that it acted as a powerful stimulant, and usually 
prolonged life until the calomel removed the disease. 
This will appear a barbarous remedy, but the pain was 
only momentary, and life was generally saved, and I 
never saw any subsequent bad effects ; for strange to say, 
in almost all, if not every case, by the time the person 
was convalescent, the wound w T as all healed ; indeed, 1 
never saw any discharge from such scalds, but this was 
natural, and was to be expected, from the debility of the 
secretory power. The abrasion appeared to dry up, as 
is well known is the case often with vesication produ- 
ced by epispastics in violent diseases of a typhoid type. 
When sinapisms acted, I never used the boiling water ; 
when they failed in very bad cases to act in 10 or 15 
minutes, I always applied it, if I thought, from the 
state of the subject, I should not have full 2 hours for 
the action of the calomel ; after the first dose of the 
mercury, there was often a slight relief of the vomiting, 
cramps, &c, but generally after the second dose these 
symptoms vanished in a great degree. 

I was called to a German lady living on the place of 
the late Mr. Robert Walsh, on the Hookstown road, his 
family physician being out of the way, when sent for. 
This was about 10 o'clock in the day. I found her in 
the second stage of the disease, vomiting severe, cramps 
violent, that peculiar purple hue under the eyes, &c. 
I gave to her immediately, 30 grains of calomel ; the 



28 



CHOLERA. 



vomiting was so excessive she partially throwed it up ; I 
repeated the dose, which was not rejected. I remained 
with her above an hour, at the end of which time, I 
again repeated the dose ; the sinapisms were used as 
common. When 1 left her she was comparatively re- 
lieved, vomiting had ceased, cramps nearly gone, and 
the purple hue of countenance very much diminished. 
I considered her cure certain. I saw her again at one 
o'clock ; I found her, contrary to expectation, sunk into 
the lowest state of collapse ; this was so contrary to 
what I anticipated, that 1 immediately inquired what had 
been done to her, for she was actually in articulo mortis. 
I was told that she continued to improve after I left her, 
appeared easy, and had one or two evacuations slightly 
tinged with bile, but that her family physician had ar- 
rived a little before 12 O'clock, countermanded the repe- 
tition of the calomel, and bled her profusely ; she died 
fifteen minutes past one o'clock. This was another 
victim to practice founded on autoptic examinations. It 
is against the abuse of inferences and practice founded 
on post-mortem examinations, that I refer to. I do not 
altogether deny their value ; to the surgeon they are of 
inestimable importance ; he has to deal with the mecha- 
nism of the machine ; they are palpable to the eye, 
he can lay his hand on the thing, it is a mere mechani- 
cal matter ; but the Physician has to do with a far high- 
er concern ; the motatory power of the vis vitae, the 
action of life with and on matter. The sequelae can only 
be seen in the dead body, the modus operandi must be 
learned by examination of the results of power and 
matter acting conjointly. 

In conclusion, to sum up the whole of my experi- 
ence ; for prevention, not only to remove all sources of 



CHOLERA. 29 

the production of impure gases, which by admixture and 
solution diminish the purity of the air, but also all 
agents which exhaust directly, by decomposition and ab- 
sorption the vitality of the atmosphere. 

Personal preventives. — Cleanliness, moderation in 
every thing, a flesh and cracker diet, the occasional 
use of an alterant laxative, and cheerfulness of mind. 

The best treatment. — Avoiding all powerful evacu- 
ants or internal stimulants, narcotics, tonics, antispas- 
modics, &c, but relying on the simple calomel for the 
cure, and sustaining the feeble life if possible by the 
application of mustard and red pepper over the whole 
chest and abdomen, and if the disease is far advanced, 
rather than lose life, boldly apply it to the raw surface 
through the agency of boiling water. From the forego- 
ing, it would be supposed that I am a great advocate for the 
excessive use of mercury ; on the contrary, I am opposed 
generally to its employment, and think that its inordi- 
nate and indiscriminate use is injurious. But in a dis- 
ease like the cholera, which has thrown so much of 
worth and beauty into the tomb, it is my duty fearlessly 
to recommend a remedy which I have found so generally 
to succeed. 



NOTES. 



Note 1. 

I am well aware that antiquarians in medicine have pretended 
to trace this disease from the most remote times to Avicenna, and from 
Avicenna down. 

Note 2. 

Towards the close of the cholera there began to prevail a severe 
bilious fever, and as the one disappeared, the number of the cases of 
the other increased, until they were nearly as numerous as the 
cholera in its greatest height. This fever was very severe, long and 
tedious in its progress, generally running into a typhoid type. Being 
still in the employ of the city, I was kept as constantly going as 
when the cholera prevailed, and there never fell under my charge, a 
case of this fever in a person who had previously had the cholera, 
and upon particular inquiry, I could never hear of any person who 
had the cholera being attacked by this disease. 

Note 3. 

I have been called to many in old ruinous buildings, in the cellars 
of unfinished houses, and even on cellar-doors ; for there are num- 
bers in the larger cities having no homes. This class of people had 
a dread of the hospitals, and generally refused to be carried there. 
I was called to many in such miserable confined holes, that it was a 
wonder to me how they could creep into them, or how any human 
being could exist when they were in. Many curious circumstances 
came to my knowledge, which verified the old adage, " That not 
one-half of the world know how the other half get on." There was 
a man who realized a handsome income, by providing lodgings for 
the homeless. He occupied a large frame house in the precincts of 



NOTES. 31 

the city. His floors were regularly chalked off in portions, six feet in 
length, and eighteen inches and two feet in breadth. His regular 
price was for an eighteen inch space, one cent and a half; for two feet 
space, two cents for a night's lodging. These were occupied by male 
and female tenants indiscriminately, who appeared to be as jealous of 
invasion, and as prompt to make battle in defence of their constricted 
space as any prince or potentate whatever. Strange to say, this 
house was generally crowded. I have been called to it to see six 
cases of cholera in one night. A more disgusting mass of mortality 
no one ever dreamed of. 

Note. — Cholera Infantum. 

The practice in Cholera Infantum is another instance where 
Empiricism has triumphed, and almost all the remedies have been 
directed to the cure of the effects or symptoms, instead of the disease. 
By such mal-practice how many thousand parents have been thrown 
into despair, and lovely children ushered into the tomb. The great 
anxiety has always been to stop the looseness of the bowels, vomiting, 
&c, and this has generally been done by anodynes and astringents. 
Some occasionally give a little rhubarb, magnesia, or chalk ; the 
crela preparata of the shops (a little clay would be equally effective 
as the latter, notwithstanding its sounding name,) averaging from 
one to five drops of laudanum to the dose. Of course, under such a 
treatment, for a time the bowels are restrained ; the doctor when he 
arrives, asks only (of the poor anxious mother, exhausted by days 
and nights of watchfulness,) how the bowels are ; pronounces the 
child better, and departs, soon to hear that another victim has 
been added to the many gone before, by the monstrous absurdity 
of applying the remedy to the symptoms instead of the disease 
itself. Cholera Infantum is caused by heat acting on the delicate 
organism of the child, producing a state of vitiated secretion — this is 
the disease ; the true remedy is to restore the secretion, and the 
child will be well — vomiting, diarrhoea, fever, and all will be gone. 
I have attended many, and never lost one with this disease. Instead 
of anodynes, absorbents, astringents, &c, the true remedy is pow- 
erful purgation — mercurial purgation — until the fever ceases, after 
which, if the disease be not relieved, small alternate doses of calomel 
given every twenty-four or forty-eight hours, until the purity of the 
secretions are restored ; after which country air and mild tonics, such 



32 NOTES. 

as an infusion of dog-wood bark or very weak chamomile tea, com- 
pletely restores the infant to its pristine health in a few days ; 
whereas under the usual practice if they survive, it is only by the 
power of constitution, and the disease wearing itself out, (after 
undergoing weeks or months of suffering,) weak and delicate, often 
leaving tendencies to diseases which in many instances lead to death. 
I remember one among many cases, that of the present Mrs. Brown, 
the mother of an interesting family of children, who, when an infant, 
from improper treatment in the commencement of this disease, was 
so reduced, that she had to take one grain of calomel every night or 
every other night for two months before she was relieved ; yet she 
gradually improved in appetite and flesh (although she was a mere 
skeleton when she commenced it,) under this treatment, and even- 
tually became very stout and hearty. 

Note. — Shipley's Servant. 

In the year 1835, I was called to a servant man of Mr. James 
Shipley, of Howard District, aged about twenty years, stout and 
muscular. This man had been actively laboring in the harvest-field ; 
the day was extremely hot ; he drank largely of very cold water in 
his heated state, and immediately fell as if shot. I was sent for ; 
living some distance off, it was an hour after the accident before I 
arrived. I found a large number of people present; the man was 
straightened and laid out on the ground, and considered to be dead. On 
examination I could perceive no symptom of life. The occurrence 
took place about half a mile from the. house. Mr. Shipley had the 
ox-cart to carry the body home ; he was put in, and I accompanied 
them to the house. On the way it occurred to me, as I had seen so 
much good effect from the application of boiling water in cholera, to 
try it on the body of this man. There happened on our arrival to be 
boiling water ready. A section of blanket was saturated with it, and 
immediately applied over the stomach, and although there was no 
visible sign of life and all thought him dead, yet in less than one 
minute after the application, it took Shipley and myself to hold him, 
his struggles were so great, and he was soon perfectly relieved. 

I mention this, that the remedy may be tried. A second case has 
not since occurred in my practice so that I could ascertain the cer- 
tainty of the remedy, or if this was only an accidental occurrence. 



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